Tube for inspecting internal organs of a body

ABSTRACT

An inspection tube ( 20 ) for use in the medical practice, in which sensors, such as a miniature electronic camera, are incorporated in the distal face of the tube. The sensors receive energy supplied via conduits ( 24, 26, 28 ) running along the length of the tube, preferably embedded within the wall. Signals of the sensors are transmitted to the rear of the tube where they are fed into receivers. Sensor cleaning can be affected in some embodiments by conducting cleaning agents through a channel in the wall of the tube. An alarm procedure can be affected by comparing sensed pattern with a reference base pattern and defining a critical deviation from the reference base.

TECHNICAL FIELD OF THE INVENTION

The present invention relates generally to a medical means of monitoringcritically ill and anesthetized patients including monitoring ventilatedpatients. More specifically, the invention is a device for monitoringpatient's organs and cavities.

BACKGROUND OF THE INVENTION

Insertion of tubes into patient's body organs, cavities and tracts is acommon procedure in emergency and critical care medicine. Anendotracheal tube may be inserted into the trachea of a patient who isin acute respiratory failure or is undergoing general anesthesia. Theendotracheal tube must be placed quickly and accurately and positionedwith its tip in the mid portion of the patient's trachea to preventaccidental slipping and to provide proper seal and ventilation of bothlungs. Similarly, a naso-gastric tube is commonly inserted through thenose or mouth into the stomach of patients who need artificial feedingor evacuation of the content of the stomach. Another tube that isfrequently inserted into a body cavity during emergency treatment is theurinary catheter. This catheter is threaded through the urethra into theurinary bladder. The correct placement of these tubes and cathetersthroughout their use is critically important.

Many patients who are critically ill or undergoing general anesthesiarequire artificial ventilation. For over 40 years the most common methodof providing artificial ventilation has been by pumping compressed airinto the patient's lungs through an endotracheal tube. This tube isinserted through the patient's mouth or nose and passed between thevocal cords into the trachea. Alternatively, a tube may be inserted intothe trachea through a tracheotomy surgical incision. For oral intubationthe operator usually uses a laryngoscope, which consists of a handle anda blade. The operator inserts the blade into the patient's mouth andadvances it until its tip lies in the pharynx beyond the root of thetongue. The handle is then used to manipulate the blade and push thetongue out of the way until the epiglottis and the vocal folds can beseen. The tip of the endotracheal tube can then be aimed and pushedbetween the vocal folds into the trachea. This method of insertion isused in the majority of intubations, but requires skill, training andexperience and is only performed by specialized physicians and licensedparamedics.

An alternative method that is often used when difficult intubation isanticipated is over a fiber optic bronchoscope. First the bronchoscopeis connected to a light source to provide the needed illumination of thefield facing its tip. The shaft of the bronchoscope is then insertedthrough the endotracheal tube and moved in as far as possible. The tipof bronchoscope is then inserted into the patient's airway and advancedunder visualization through the bronchoscope's eyepiece or a videodisplay in between the vocal folds into the trachea. The endotrachealtube can now be pushed down the bronchoscope shaft and moved between thevocal folds into the trachea. The endotracheal tube can now be securedand the bronchoscope removed to free up the lumen of the endotrachealtube. While the bronchoscopic method is safer than with thelaryngoscope, the equipment needed is expensive, delicate and morecumbersome and is seldom found in the field or on emergency medicalvehicles.

Securing the endotracheal tube and preventing its inadvertent movementduring use is critical to the prevention of dire accidents. Inflating acuff that surrounds the tube near its tip occludes the space between theouter wall of the tube and the inner wall of the trachea to provide anairtight seal. The cuff is connected to the external end of theendotracheal tube through a thin channel to in the tube's wall. Thechannel is connected to a one-way valve through which air can beinjected to inflate the cuff to the desired pressure and volume. Thecuff is also helpful in securing the tube in place, but additionalfasteners are usually applied around the head to prevent the tube fromslipping in or dislodging.

Once the tube has been inserted, it is mandatory to verify its correctposition. Accidental insertion of the tube into the esophagus or placingit too deep inside the airways, so that its tip is lodged in one of themain stem bronchi instead of in the trachea may lead to catastrophicconsequences and asphyxiation. Many methods are available to verify theendotracheal tube placement. Auscultation of both sides of the chest isusually done to verify symmetric air entry into both lungs. A chestx-ray is another well-tested method of verifying the tube placement. Thex-ray picture reveals the relationships between the endotracheal tubetip and the tracheal first bifurcation (carina). X-ray pictures may beand should be taken whenever an endotracheal tube is placed orrepositioned. Additionally, the tube placement may be verified through afiber optic bronchoscope, by a suction bulb, or through sending andreceiving an acoustic signal. These methods are used to verify theinitial placement of the endotracheal tube. There are no currentlyavailable means for continuous monitoring of the actual placement of thetube.

The advantages of fiber optic visualization were combined with thesimple design of the laryngoscope as disclosed by several patents andscientific papers. Additionally, the use of visualization stylets whichinclude means for seeing the airways during the insertion of anendotracheal tube have been described. However, there are no knownmethods for incorporating the visualization means permanently into theanterior face of the endotracheal tube so that visualization of theairways can be accomplished during the insertion and continuouslythereafter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic isometric scheme of the tube of the inventionincorporating three types of conduits;

FIG. 2 is a schematic isometric description of a portion of the anteriorface of the tube of the invention into which a miniature video camera isincorporated;

FIG. 3 is a schematic description of the items commuting along the tubeof the invention, related to the performance of inspection tasks.

DETAILED DESCRIPTION OF THE PRESENT INVENTION

In accordance with the present invention, a multifunctional inspectiontube is provided for collecting information about internal cavities andspaces in the body of a patient or an animal in association with theinsertion of an inspection tube in the body. The multifunctionalinspection tube is a modified medical tube such as an endotracheal tube,catheter, a gastric feeding tube. In accordance with the presentinvention the tube is equipped with means to examine both thepositioning of the inspection tube with respect to body organs and thefunctional aspects of the body during and after the insertion. Thus, thetube of the invention may be used to perform not only customary medicaltreatment tasks of conveying gasses and or liquids to and from thepenetrated organs, but also inspection tasks that examine the reactionto such treatment and otherwise the condition of the penetrated organs.The multifunctional inspection tube of the invention incorporates ameans of receiving signals relating to the condition of the penetratedorgans such as visual and audio signals by employing suitable sensorsincorporated at or near the anterior face of a tube. The signalsproduced by the sensors are transmitted via wires or communicationfibers running along the length of the tube to a connector or a wirelesstransmitter located at the posterior portion of the tube near itsstandard connector to the ventilation source, gastric tube feeder orurinary collecting device. The signals are received by a receivercontaining a suitable signal conditioning means for subsequentprocessing, display, recording and or monitoring. The structural conceptof the invention is better explained with reference to FIG. 1. A portion20 of a multifunctional inspection tube of the invention is shown,including an anterior face 22. Channels and a conductor are associatedwith the wall of the tube. A totally embedded channel 24 runs along thelength of the inspection tube within its wall, alongside an openrecessed channel 26. A conducting element 28 runs along the length ofthe tube without being embedded in the wall of the tube, rather it isattached to the wall of the tube and occupies a space in the lumen ofthe tube. The conduit may be partially embedded in the tube or it may beinserted within a recess or it may be threaded within a totally embeddedchannel without being attached to the tube. Even in embodiments in whichthe lumen contains a conducting element attached to the wall asdescribed above, the lumen of the tube is still largely free fortransferring liquids or gasses in both directions. With this respect,embodiment in which the channels and conducting elements embedded orwholly inserted in the wall may be preferable.

A typical feature of the multifunctional inspection tube is theacquisition of internal images of the body. For acquiring the images, animage sensor may be employed, such as a miniature electronic cameraemploying a CCD or a CMOS chip incorporated in the anterior face of theinspection tube. In one embodiment, the camera is incorporated in arecess in the wall of the tube as described in FIG. 2 to which referenceis now made. A portion of an inspection tube is shown, within the innerside 40 of which, a camera 42 is inserted in a recessed channel,protruding from the anterior face 44 of the tube. The signal of thecamera is transmitted by a conducting element 46, typically a copperwire or an optical fiber. The camera's lens is facing away from thetube. The signals arriving from the camera are subsequently fed to areceiver and may be subsequently displayed on a screen, which may be astand-alone mini screen, an ordinary video screen, or a portion of thedisplay screen ordinarily used to monitor the physiological parametersand well-being of the patient. In some embodiments of the invention, afiber optical element running along the length of the tube is used toconvey light to illuminate the field of view ahead of the anterior faceof the inspection tube. Alternatively, a light source may be associatedwith the proximal face of the tube. Examples for light sources areminiature halogen lamps, light emitting diodes (LED), lasers, or anyother kind of light-emitting source of suitable size. An alternativemethod of illumination is by constructing the inspection tube made oflight-conducting material. In some embodiments of the invention, meansfor keeping the lens of the camera and/or other sensors clean and clearare employed. The airways, stomach or urinary bladder of an ill patientare often filled with secretions that may be thick and viscous. Thus, itis quite possible that the secretions may lodge on the lens and obscureits field of view, or on other sensors thereby modifying theirresponsiveness. To overcome such an obstacle, a constant or intermittentflow of air or physiological fluid is pumped through a channel in thetube's wall, whereby the outlet of the channel is aimed directly overand around the lens or the sensor's active surface. This flow may begenerated by a simple flow source or by a device that is triggered toemit flow upon command from a human care giver, a timer or a softwareprogram that monitors the signal and determines when clearing action isrequired.

In general, the inspection tube is used as bi-directional conveyingplatform for various elements required for the fulfillment of itsinspection tasks. This is described schematically in FIG. 3 to whichreference is now made. Tube 52 receives activation energy 54 of one orseveral types on its rear end, and downloads information 56, raw orprocessed at the same end. At the anterior end 58, the tube receivessignals 60 of one or several types, and spends energy 62 as will beelaborated later on.

In some embodiments of the invention, a microphone is employed in thetube. Such a microphone can be incorporated in the wall of the tube.Such a microphone receives acoustic signals from at least the vicinityof the tubes anterior, and transfers the signals, raw or processed tothe rear of the tube for further downloading and processing.

A plurality of sensors can be effectively employed in the anterior faceof the tube of the invention, the non exhaustive list includes cameras,video cameras, microphones, pressure transducers and thermal sensors.Gas sensors, for example sensors for particular gasses such as oxygenand carbon dioxide may also be employed. The energy required to activatesuch sensors is supplied by conduits of energy such as electric wiresincorporated in the tube. In addition, auxiliary energy can be suppliedto the vicinity of the anterior face of the tube for the purpose ofcleaning and clearing the sensors active facets by flushing them withcleaning media such as gases, humidified air or oxygen, or liquids,typically a physiological solution, through channels in the wall of thetube. Liquids and or gases for flushing are energized and conductedtypically via a totally embedded channel. The inspection tube of theinvention may be used alone or in combination with other catheters andtubes that are ordinarily inserted into a body organ, tract or cavitysuch as the esophagus, the stomach, the intestine, the colon, theurinary bladder, the pleural space, lung airways and/or the peritonealcavity. The present technology may be applied in various medicalpractices and treatments such as: artificial ventilation of the lung,feeding or removing the content of the stomach, draining urine from thebladder, draining the gas and feces from the colon, and draining orinjecting into a surgically accessed cavity such as the pleural space,or the peritoneal cavity.

The sensors of the tube transmit one or more signal types, which areeither preprocessed in the sensor for example on the CCD chip, or may besent raw, to be further processed by analog or digital circuits to yieldinformation relating to the status of the organ or body cavityinspected. The receiving and or processing devices such as, monitors,displays, storage means, analyzers, DSP processors, computers andgenerators of alarm signals are typically connected by one or aplurality of connectors to the tube. The tube of the invention may beused for insertion through orifices such as the nose, mouth, urethralmeatus, rectum, or a surgical incision.

The transmission of raw or preprocessed signals is affected throughconductors along the tube such as wires or optical fibers, which connectto a connector at the rear of the tube. A wireless transmitter ortransceiver may be applied anywhere suitable on the tube, typically atthe rear, for communicating with a console containing a receiver andprocessor and or a control module.

The inspection tube of the invention may also be used to detect changesin indications of vital functions of a patient. Accordingly, image andacoustic signal are being detected, processed and compared to areference base picture or sound structure. An alarm is set as soon ascertain changes in the indication pass a predetermined threshold. Forexample, the accumulation of secretions, or development of excessive ordiminished lung noises are abnormal.

1. A multifunctional tube capable of conveying at least one itemselected from the group consisting of gasses and liquids into and out ofthe body wherein an imaging sensor is incorporated in the anterior faceof said tube and wherein: at least one conduit of energy to activatesaid imaging sensor is associated with the wall of said tube; at leastone conducting element for transmitting signals of said imaging sensorto the rear end of said tube, and at least one receiver for saidsignals.
 2. A multifunctional tube capable of conveying at least oneitem selected from the group consisting of gasses and liquids into andout of the body as in claim 1 and wherein the wall of said tubecomprises a channel.
 3. A multifunctional tube capable of conveying atleast one item selected from the group consisting of gasses and liquidsinto and out of the body as in claim 2 and wherein the wall of said tubecomprises a totally embedded channel.
 4. A multifunctional tube capableof conveying at least one item selected from the group consisting ofgasses and liquids into and out of the body as in claim 2 and whereinthe wall of said tube comprises a recessed channel.
 5. A multifunctionaltube capable of conveying at least one item selected from the groupconsisting of gasses and liquids into and out of the body as in claim 1and wherein a lighting element is associated with said anterior face ofsaid tube.
 6. A multifunctional tube capable of conveying at least oneitem selected from the group consisting of gasses and liquids into andout of the body as in claim 5 and wherein said lighting element is anoptical fiber running along the wall of said tube.
 7. A multifunctionaltube capable of conveying at least one item selected from the groupconsisting of gasses and liquids into and out of the body as in claim 5and wherein said lighting element is a light emitting source.
 8. Amethod for placing a tube into internal organs of a body wherein animaging sensor is incorporated in an anterior face of a tube capable ofconveying at least one item selected from the group consisting of gassesand liquids into and out of the body and wherein: energy is supplied tosaid anterior face of said tube for at least activating said at leastone imaging sensor by way of at least one conductor running along saidtube; signals are transmitted from said at least one imaging sensor to arear of said tube, and said signals are fed into a receiver of saidsignals.
 9. A method for placing a tube into internal organs of a bodyas in claim 8 and wherein some of said energy supplied to said anteriorface of said tube is used for keeping a sensor clear.
 10. A method forplacing a tube into internal organs of a body as in claim 8 and whereinsaid signals are raw.
 11. A method for placing a tube into internalorgans of a body as in claim 8 and wherein said signals are preprocessed.
 12. A method for detecting changes in indications of vitalfunctions of a patient, wherein at least one imaging sensor incorporatedin the anterior face of a tube used to convey fluids into and out of thebody, in said patient, continuously sends signals which are interpretedto indicate changes of said indications.
 13. A method for detectingchanges in indications of vital functions of a patient, as in claim 12and wherein an alarm is set when a change of said indications of vitalfunctions of a patient pass a predetermined threshold.
 14. A tube forperforming medical tasks of conveying at least one item selected fromthe group consisting of gasses and liquids, to and from penetratedorgans and wherein said tube is also used for inspection tasks utilizingat least one imaging sensor for examining at least the reaction of saidpenetrated organs to the penetration.
 15. A method for detecting changesin indications of vital functions of a patient, as in claim 12 andwherein said signals are images.